Aetiology and pathophysiology Aetiology

The main causes of vascular dementia are cerebrovascular disorders and their risk factors. The prevalent cerebrovascular disorders include large artery disease (artery-to-artery embolism, occlusion of an extra- or intracranial artery), cardiac embolic events, small vessel disease (lacunar infarcts, ischaemic white-matter lesions) and haemodynamic mechanisms.(1 ,1 and 15) Less frequent causes include specific arteriopathies, haemorrhage (intracranial haemorrhage, subarachnoidal haemorrhage), haematological factors, venous disease, and hereditary disorders. There may be as yet undiscovered causes.

In most patients diagnosed with vascular dementia, several aetiological factors are involved. However, the roles these factors play have not been identified in detail, and it is not certain which of these mechanisms distinguish vascular dementia from cerebrovascular disease without dementia. ^^I16,,17)

Risk factors for vascular dementia can be divided into vascular factors (e.g. arterial hypertension, atrial fibrillation, myocardial infarction, coronary heart disease, diabetes, generalized atherosclerosis, lipid abnormalities, smoking), demographic factors (e.g age, education), genetic factors (e.g. family history, individual genetic features), and stroke-related factors (e.g. type of cerebrovascular disease, site and size of stroke). (1, ,19) Hypoxic ischaemic events (cardiac arrhythmias, congestive heart failure, myocardial infarction, seizures, pneumonia) may be an important risk factor for incident dementia in patients with stroke. ^

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